Background: Coronary Heart Disease (CHD) & depression problems are increasing concerns globally as cardiovascular diseases (CVD) solely account for almost one-half of NCD deaths. Similarly, 280 million people i.e., 3.4% of the world population are suffering from depression. There is a direct association between CHD and depression as studies show that up to one in five people with CHD may experience depression. Coronary artery disease (CAD) is the most common type of CHD in the United States. There have been studies examining the association between these, but none in Tennessee. This study aims to investigate the association between CHD and depression. Methods: We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults aged 18 years and extracted data for Tennessee (n=4,788). Logistic regression analyses were conducted to test the association between coronary artery disease and depression. We controlled for the past month's income, race/ethnicity, educational status, gender, and age. Results: Overall, 25.5% (n=1,209) reported having been diagnosed with depression, while 6.0% (n=289) reported coronary artery disease. Coronary artery disease predicted higher odds of depression (OR=1.86, 95% CI, 1.44, 2.41) along with low income (OR=2.14, 95% CI, 1.85, 2.48) and female gender (OR=1.94, 95% CI, 1.69, 2.23). Conclusion: High prevalence of depression is one of the major health challenges in Tennessee. Similarly, the prevalence of coronary artery disease was also prominent. We found a significant association with higher odds of depression among patients with coronary artery disease. Along with this, low income and female gender were also associated with depression. To address patients with depression, targeted efforts and disease management are needed among patients with CHD. More research focusing on the other associated variables is to be studied. Keywords: Coronary Heart Disease, Depression, Health disparities in Tennessee

Loneliness is a widespread public health concern. Loneliness may be less frequent but have more severe consequences for cardiovascular disease (CVD) in a collectivist (e.g., Japanese) versus individualist (e.g., United States [U.S.]) culture but little is known about cross-cultural associations of loneliness. This study determined if loneliness would be higher in the U.S. and in persons lower in collectivism. We also studied if loneliness would be positively associated with CVD indicators and if these associations would be stronger in (1) Japan than the U.S. and (2) individuals higher in collectivism. U.S. (n = 529) and Japanese (n = 292) adults from the Midlife in the United States Series, aged 36 to 78, completed psychosocial questionnaires, provided blood samples, and underwent a physical exam. Logistic regression and path analyses using structural equation modeling determined individual differences in loneliness, whether loneliness predicted CVD indicators (e.g., metabolic dysregulation, inflammation, blood pressure, and sleep dysfunction), and whether nationality and collectivism moderated these associations. Japanese adults reported less loneliness compared to the U.S. Unexpectedly, loneliness did not predict any CVD indicators. For U.S. adults with low interdependence, loneliness was associated with elevated metabolic dysregulation. For Japanese adults, loneliness was associated with decreased metabolic dysregulation. We decided to test additional models that included gender as a moderator of the association between loneliness and CVD indicators. Complex associations between gender, nationality, interdependence, and loneliness were found. Clinicians should consider addressing metabolic dysregulation and sleep in lonely patients, especially males and U.S. females. Future work could investigate how loneliness is appraised by Japanese men and U.S. women, and how loneliness affects the health behaviors and eating patterns of these groups.

High blood pressure (HBP) is a primary risk factor for cardiovascular disease (CVD). Identification of modifiable dietary risk factors for HBP is crucial. The objective of this dissertation is to estimate the effects of long-term protein, dairy, and yogurt intakes on risk of HBP and subsequent CVD risk among those with HBP. Data from four prospective studies of middle-aged adults were used: the Framingham Offspring Study (FOS) (n=1,361), Nurses’ Health Study (NHS) (n=66,987), NHS II (n=84,368), and Health Professionals Follow-Up Study (HPFS) (n=30,512). Diet was assessed via 3-day diet records in FOS and semi-quantitative food frequency questionnaires in NHS, NHS II, and HPFS. HBP was assessed by mercury sphygmomanometer or anti-hypertensive medication use in FOS and self-report in NHS, NHS II, and HPFS. Self-reported incident CVD was validated by physician review in the NHS and HPFS. Cox proportional hazard models were used to calculate hazard ratios, 95% confidence intervals (CI) associated with cumulative average dairy intakes while controlling for potential confounding by age, sex, height, activity, smoking, energy, diet quality scores, fruits and vegetables (FV), fiber, and fat intake. Higher total protein intake led to a 40% (95% CI: 0.45-0.78) HBP risk reduction in FOS. When combined with higher FV or fiber consumption, higher protein intake resulted in a HBP risk reduction of 39% and 51%, respectively. Higher total dairy (3-<6 s/day) led to 13% (95% CI: 0.83-0.92; p-trend<0.0001), 26% (95% CI: 0.69-0.78; p-trend<0.0001), and 9% (95% CI: 0.84-0.98; p-trend<0.0001) reduced HBP risks across NHS, NHS II, and HPFS, respectively. In pooled analyses across these cohorts, higher total dairy (3-<6 s/day) or yogurt (≥5 s/week) intakes in combination with higher diet quality scores resulted in 23% (95% CI: 0.73-0.80) and 31% (95% CI: 0.65-0.74) HBP risk reductions, respectively. Among hypertensives, regular yogurt consumers (≥2 s/week) had statistically significant 17% and 18% lower risks of CVD in NHS and HPFS, respectively; HPFS men consuming 2-<6 s/d of total dairy also had an 11% lower CVD risk. These results suggest that higher usual intakes of total protein, dairy and yogurt have beneficial effects on HBP risk and subsequent CVD in middle-aged adults. / 2018-06-15T00:00:00Z

The current project used data from the Health & Retirement Study (HRS) 2016 wave and assesses the relationship between everyday racial/ethnic discrimination and risk factors for cardiovascular disease. The role of acculturation and social support on this relationship was also considered. The sample size consisted of 3,994 non-Hispanic White, 1,140 non-Hispanic Black, and 842 Hispanic older adults. The results suggest that non-Hispanic Black and Hispanic individuals endorse higher perceived everyday racial/ethnic discrimination (p < .001) in comparison to non-Hispanic White individuals. Additionally, non-Hispanic Black adults have higher systolic and diastolic blood pressure readings (p < .001) than non-Hispanic White and Hispanic adults. Support for the direct and moderating role of certain aspects of social support and acculturation on health outcomes/behaviors related to cardiovascular disease risk among non-Hispanic Black (R2 = .07, F(15, 415) = 2.06, p= .011) and Hispanic (R2 = .30, F(5, 34) = 2.97, p = .025) older adults, respectively, were found. The limitations and clinical implications of the study are further discussed.

Cardiovascular disease is the leading cause of death in firefighters (FF) around the nation. Recent observational studies have emerged suggesting that FF consume calorically dense foods, high in sugar and fat, but low in nutritional value which can exacerbate heart diseases and impair performance. The potential to improve cardiometabolic and performance measurements when following a carbohydrate (CHO) restricted diet (CRD) has gained interest in the literature. To date, only one study has employed a nutrition intervention in FF, yet its’ focus was on nutrient dense foods and antioxidant supplements. Therefore, the purpose of this study was to examine the cardiometabolic and performance effects of a 28-day CRD in FF. 15 career FF participated and finished the present study. Participants reported to the laboratory on 9 separate occasions. Trial 1 consisted of participants having a blood draw performed for assessment of their heart disease risk followed by body composition, blood pressure, and a glucose challenge test (GCT) to assess glucose impairment following ingestion of a 75 g glucose beverage. Trial 2 consisted of a graded exercise cycling test with 5 stages followed by a maximal Wingate for 30 s. Finally, the last trial included the FF physical performance assessment (FPPA) which consisted of a 2.41-km run followed by 2 min of maximal pull-ups, push-ups, and sit-ups. The first 3 trials were used as familiarizations, the second 3 trials were used as baseline measurements, and the last 3 trials followed the 28-day CRD. The CRD consisted of ad-libitum consumption of fat and protein and keeping CHO < 25% daily kilocalorie intake. Dependent variables measured pre- and post-diet included body composition, lipid profile, insulin, cortisol, c-reactive protein (CRP), GCT, substrate oxidation rates, Wingate variables, and the FPPA. Following the diet, participants had significant reductions in CRP, blood pressure, 2.41-km run time, CHO oxidation rates, and fat mass. Participants also had significant increases in high density cholesterol count, fat oxidation rates, and pull-up repetitions. Overall, our results show that a CRD in a high-stress occupation can favorably change markers of heart disease and body composition without decrements to physical performance.

Cardiovascular disease is among the leading causes of death in the US. It stems from the pathological buildup of plaque within the vasculature known as vascular calcification. Medial calcification, or arteriosclerosis is the buildup of plaque within the medial layer of the arteries resulting in artery wall stiffening and reduction of blood flow. Evidence suggests that the vascular smooth muscles cells (VSMCs) that line the medial layer of the arteries, undergo a phenotypic switch to osteoblast-like cells to deposit calcium while in this pathological state. The Wnt/BETA-catenin pathway could potentially play a role in the phenotypic modulation. Inhibition of the Wnt signaling pathway could be a promising approach to combat vascular calcification. Sclerostin (SOST) has been shown to be upregulated during arteriosclerosis in a manner that is indicative of the possible therapeutic potential of the protein. Therefore, we propose to confirm the role of Wnt signaling in vascular calcification and investigate the effects of SOST treatment on vascular calcification.

This study addressed obesity of youth in a predominantly African-American school and was concerned with the implementation of a CVD intervention program, Project Health Curriculum, for high school students, focusing on early health promotion and support to children at risk of developing adult diseases. A health promotion program was implemented at a high school in Canton, Mississippi, to equip students with information to help reduce risk behaviors that could lead to health problems. This intervention was conducted in the health and physical education classes. Students were given the opportunity to report their knowledge and behaviors by participating in a pretest. A posttest was completed after the health promotion intervention. A Wilcoxon Signed Ranked test was computed to analyze the differences between the pretest and posttest scores of the students on the Project Health Student Survey (PHSS) to determine if the intervention program impacted their attitudes, practices, and knowledge regarding their risk behaviors and practices. The posttest served as the student outcome measure and indicator of the effectiveness and perceived usefulness in modifying student risk behaviors when compared to the pretest scores. Changes in student behaviors were found in several of the categories examined. The results of the study indicated that a carefully designed prevention/intervention program within the school curriculum can positively impact student behavioral practices to improve students’ quality of life. As the State of Mississippi deals with the epidemic of obesity and the prevalence of CVD, preventing these diseases from increasing is a priority. Strategies and programs for weight maintenance, weight reduction, and health promotion must become a public health and education priority, especially among the youth.

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